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Identifying children at low risk for bacterial conjunctivitis
James A Meltzer1, Sergey Kunkov, Ellen F Crain
1Lewis M. Fraad Department of Pediatrics (Emergency Medicine), Jacobi Medical Center and Albert Einstein College of Medicine, 1400 Pelham Parkway S., Bronx, NY 10461, USA. jamesmeltzer@yahoo.com
Insights
Clinicians can identify children unlikely to have bacterial conjunctivitis using four key factors. This approach may reduce unnecessary antibiotic prescriptions for pediatric conjunctivitis.
Area of Science:
- Pediatrics
- Ophthalmology
- Infectious Diseases
Background:
- Bacterial conjunctivitis is common in children.
- Accurate diagnosis is crucial to avoid overtreatment with antibiotics.
Purpose of the Study:
- To identify clinical factors predicting low risk for bacterial conjunctivitis in children.
- To develop a model for reducing unnecessary antibiotic use.
Main Methods:
- Prospective observational cohort study in a pediatric emergency department.
- Enrolled children aged 6 months to 17 years with conjunctivitis symptoms.
- Used logistic regression to identify predictors of negative bacterial culture.
Main Results:
- 35.3% of conjunctival cultures were negative.
- Factors associated with negative cultures included: older age (≥6 years), presentation April-November, watery discharge, and no morning eyelid crusting.
- Presence of 3 or 4 factors predicted negative cultures with 76.4% and 92.3% accuracy, respectively.
Conclusions:
- A combination of four clinical factors can identify children at low risk for bacterial conjunctivitis.
- This clinical prediction model may help reduce routine antibiotic administration for pediatric conjunctivitis.
Objective:
To identify a population of children at low risk for bacterial conjunctivitis on the basis of history and physical examination findings.
Design:
Prospective observational cohort study.
Setting:
Urban pediatric emergency department.
Participants:
Children aged 6 months to 17 years with conjunctival erythema, eye discharge, or both. The exclusion criteria were eye trauma, exposure to a noxious chemical, contact lens use, and antibiotic drug use in the past 5 days.
Interventions:
Clinicians completed a checklist of signs and symptoms and collected a conjunctival swab for bacterial culture.
Main Outcome Measures:
The chi(2) test, the Mann-Whitney test, and logistic regression were used to create a prediction model for a negative bacterial culture.
Results:
Of 368 patients enrolled, 194 (52.7%) were males. The median patient age was 3 years (interquartile range, 1-5 years). Conjunctival cultures were negative in 130 patients (35.3%). Age 6 years or older, presentation in April through November, no or watery discharge, and no glued eye in the morning were the clinical factors found to be independently associated with a negative conjunctival culture. If 3 factors were present, 76.4% (95% confidence interval, 63.6%-85.6%) of patients had a negative culture. If all 4 factors were present, 92.3% (95% confidence interval, 66.1%-98.2%) of patients had a negative culture.
Conclusion:
The combination of 4 clinical factors may enable clinicians to identify children at low risk for bacterial conjunctivitis and may reduce routine antibiotic drug administration.
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